Put to the test

Once a year or so, Roy Tialavea is summoned from his classes at Oceanside High School to report to the athletic director's office bathroom. He receives a urine specimen cup and heads for a stall.

The 17-year-old is unruffled. Random drug testing has been going on for two years at the school. He's used to it. "I don't use drugs so I don't have to worry about getting caught," he says.

His mother, Robyn, thinks her son steers clear of drugs and alcohol. But, she says, no parent can know for sure what a teenager is up to.

"If he doesn't like testing, I really don't care," she says. "I think it's a wonderful tool. It creates the fear that they could be tested."

Call it the 2007 version of "just say no."

Concerned with high rates of adolescent substance abuse, hundreds of middle schools and high schools nationwide have quietly begun testing some or all students for drugs -- to the dismay of some health and addiction experts.

Although less than 5% of all high schools have such programs, testing is now common in schools throughout Texas, Florida, Kentucky and parts of California. In Southern California, many private high schools have implemented drug testing, as have several public school districts in Orange County and San Diego. Nationwide, as many as 1,000 schools have established programs, according to the White HouseOffice of National Drug Control Policy.

The number of schools administering drug tests is expected to grow. Federal funding for school drug testing increased 400% between 2003 and 2006. The Bush administration spent $8.6 million on such programs last year and has requested $17.9 million for fiscal year 2008.

"This is the best new idea to reduce the onset of drug use," says Dr. Robert L. DuPont, president of the Institute for Behavior and Health, a nonprofit drug policy organization that has studied school testing. "About half of high school seniors have used an illicit drug by the time they graduate and about one-quarter are regular users by the time they graduate. Those figures are worrisome."

School-based drug testing gives kids a reason to say no, say DuPont and other proponents. The tests are meant to identify students who are using and guide them into counseling or treatment programs before they develop addictions.

But health officials, by and large, oppose school-based drug testing. NAADAC, the Assn. for Addiction Professionals, has released a statement critical of such programs. And in March, the American Academy of Pediatrics cautioned against random school-based drug testing until more research is completed. The two groups are among those who say testing is not reliable enough, violates trust between adults and teens and is not set up to deal effectively with students who have positive results.

Though adults debate testing's merits, students at some high schools hand over urine specimen cups as comfortably as they turn in late library books.

"Kids pretty much know who does drugs and who doesn't," says Alex Podobas, a senior at San Clemente High School, which has had voluntary testing for several years. "But no one says, 'Oh, you're a pothead' when you get called out for testing."

Screening kids for marijuana, cocaine, amphetamines and other illegal drugs at school is an offshoot of two decades of experience with workplace and military drug testing, experts say. Testing methods have improved during that time to reduce the number of false test results while providing greater privacy and confidentiality, says DuPont.

And though substance abuse among teens has dropped in the last decade, parents and school administrators still consider the rates unacceptably high. Just over 20% of eighth-graders and about half of all high school seniors say they have taken an illicit drug, according to 2006 data from Monitoring the Future, the University of Michigan's nationwide annual survey. About 30% of high school seniors say they have been drunk in the last month.

Little faith is put in traditional classroom drug education programs to further drive down substance abuse rates, says Jennifer Kern of the Drug Policy Alliance, a New York City-based organization that focuses on a harm-reduction approach to drug education.

"People are overwhelmed and are looking for new approaches," she says. "A lot of the concern comes from a good place. We haven't done a good job preventing substance abuse."

School drug testing got its biggest boost in 2002 when the Supreme Court ruled that schools may conduct random drug tests among students who wish to participate in school-sponsored extracurricular activities, such as sports, marching band or debate team.

"Fifteen years ago, school drug testing was too controversial," says John P. Walters, director of the White House Office of National Drug Control Policy. "People thought the test was going to throw kids out of school or give them a criminal record. The Supreme Court decision was an enormously positive step."

But critics say the court's decision opened the floodgates for programs that have not been studiously researched or properly evaluated.

"If you look on the surface, drug testing seems like a good idea; a simple thing to do," says Dr. Sharon Levy, director of the Adolescent Substance Abuse Program at Children's Hospital Boston. "It's only when you sit down and look at it closely that it really starts to unravel a bit."

Chief among the pediatricians' complaints is the reliability of testing.

A study published in April in the journal Pediatrics found a substantial risk of error even when drug testing was performed as part of an established adolescent substance abuse program. In the study, Levy and her colleagues reviewed 710 random urine tests from 110 teens and compared the results with confirmatory lab tests. (Initial screening samples should be confirmed with a second, more rigorous, analysis -- something most school programs say they do.) They found 12% of the tests were subject to misinterpretation. For example, some of the urine samples were diluted (despite rigorous collection procedures designed to prevent kids from cheating) and could not be interpreted properly.

Further, of the samples, 21% were positive due to legitimate prescription drug use, Levy says. And several samples that were found in confirmatory testing to be positive for the painkiller OxyContin -- a popular drug of abuse among teens -- were identified as negative in the initial screen.

"Drug testing is premature policy," says Levy. "We need to understand the combination of risks and costs compared to the benefits. That hasn't been done at all."

Further, critics say, the drug testing panels used by schools are typically those used in the workplace -- screens for marijuana, amphetamines, cocaine, opiates and PCP. The panels usually do not assess alcohol or other drugs kids may be likely to use, such as inhalants, OxyContin and Ecstasy. Standard urine tests only detect use that has occurred in the last 48 to 72 hours.

Negative screens may mislead parents, school personnel and the community from searching for a truer picture of adolescent drug and alcohol use, Kern says.

"Parents can say 'OK, the schools are doing testing, we'll know what is going on,' " she says. "But drug testing gives you very little information. It can give parents a false sense of security."

Even the belief that testing deters kids from using drugs or gives them a peer-worthy reason to say no has not been proven, Kern says. A 2003 study by the University of Michigan surveying 76,000 students found no difference in marijuana or other illicit drug use in schools with testing compared with those without programs.

Podobas, the San Clemente senior, says few students fear being caught. The tests don't pick up all drugs and are administered too infrequently to worry teens, he says. Others have learned to beat the system by sharing a clean urine sample when called to the bathrooms in groups. "I don't think it has lessened the number of kids using drugs," says Podobas, although he thinks some kids use less frequently than they otherwise would.

Others critics of the program say school drug testing can make teens feel guilty before being proven innocent. While many programs -- such as several in Orange County -- only test students if they and their parents consent, kids may feel that adults distrust them, Kern says.

"There may be unintended consequences to drug testing," says Dr. Howard Taras, a pediatrics professor at UC San Diego, who studies school health issues. "Kids may be deterred from joining a sport or extracurricular activity because they will be tested. Those are the kids that most need extracurricular activities. They may not get engaged in math or science but they may get engaged by a sport or dance class."

Proponents of drug testing say such shortcomings simply don't exist in most schools. The programs, they say, are diligent about collection procedures and lab analysis, privacy issues and follow-up for kids found to have used drugs.

"Where are they finding these programs doing the bad things?" says DuPont of the critics. A study by his office of nine programs found all were following testing protocols and handling kids with positive tests nonpunitively.

Even if testing programs aren't perfect, recent research on the effect of drug use on adolescent brains warrants an aggressive approach to the problem, Walters says. Studies show that heavy drug use during adolescence may permanently damage parts of the brain related to learning and memory. People who avoid drinking and using drugs before age 21 are far less likely to abuse drugs or develop an addiction later.

"This is an area where doing the right thing for our kids is durable," Walters says. "We can change the face of substance abuse for generations."

Students feel secure knowing that adults are savvy about drug use in their schools, proponents add. "Middle and high school kids are aware of their peers who are involved in drinking and drugging," says Walters. "They will frequently ask 'Why do we look the other way? Why do we allow this to happen?' In schools with random drug testing, they feel safe."

Local school administrators say programs have drawn little protest from parents and students.

In Oceanside Unified School District, which is in its second year of testing all high school students who wish to participate in sports, community focus groups are held on a regular basis to gauge reaction. The program is funded through the Office of National Drug Control Policy.

"Our community has always been cooperative, and I think it's because we included them in the process when we were developing the program," says Tim Ware, the district's school intervention manager. "I think our kids have reacted better than anyone. It's part of what we do."

One of the few complaints, he says, is that athletes feel they are being singled out and that all students should be randomly tested.

A more common approach to testing, at least in California, are voluntary programs in which both the students agree to enroll in random testing with parental consent. Jon Hamro, athletic director and secondary teaching assistant principal of San Clemente High School, launched one of the state's first school-based testing programs in 2001. The program has expanded to each high school in the Capistrano Unified School District, which encompasses much of south Orange County. Recently three district middle schools began offering testing.

The voluntary nature of the program has taken the steam out of would-be objectors, Hamro says. Samples are collected by an outside lab and the results shared with the student's parents -- not school officials. Students with positive results are not punished.

"We took a tack of how can we do this where there are no privacy issues and yet it's a powerful tool to dissuade kids from using," he says. "It's invisible to the administration, but it's very visible to the kids."

At San Clemente High School, just over half of the school's 3,100 students are enrolled. Students testing positive are referred to either fee-for-service or free counseling, including confidential counseling on campus.

A survey conducted of 2,500 students at the high school last year showed the program is having an effect, Hamro says. Almost 60% of the students said the decision on whether or not to enroll in the program prompted a discussion at home about substance abuse. Almost 60% of the students said that the program should continue and 48% said it made it easier for them to avoid using drugs. Just over one-quarter said testing had reduced their frequency of drug use.

The study will be published in June in the American School Board Journal.

Even those who disagree about the merits of school-based drug testing agree that more research should be done to evaluate whether the programs reduce drug use and help students who are caught using.

"There are these two sides and they can argue until they are blue in the face," says Taras. "But until you study it, you can't really say anything about it."

Schools, however, may not wait for academia to weigh in, especially if the federal government extends money for testing programs.

"I actually believe that what you'll see is a rapid adoption of this," says Walters. "In a relatively short period of time we're going to look back and say 'Why did it take us so long to do this?' This is safe and it's enormously powerful."